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Rock Climbing Injuries

Sammi Iannucci

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Background:

Rock climbing injuries is an area that I am passionate about as a climber myself and a member of UNC’s climbing team. I am driven to help improve longevity in these athletes who are susceptible to injury if not informed on concepts such as proper training load and warmup. I am interested in working with this population in the future to help them rehab these injuries and return to climbing and there is a great opportunity emerging in physical therapy to work with this growing population. With this project I wanted to expand my knowledge base on climbing injuries including which are the most common, what causes them, injury risk factors, movement patterns that lead to injury, prevention, and rehabilitation.

Statement of Need:

Rock climbing is a rapidly growing sport that produces a variety of injuries, many of which are not commonly seen in other sports due to the unique demand climbing places on the upper extremity, particularly the fingers. It is also unique in the sense that many start the sport without formal training or coaching and may not have the knowledge to train in a manner that avoids preventable injuries. There is a need for climbers and those who treat climbers to gain a greater understanding of these injuries, their prevention, and rehabilitation, and how to safely return to climbing post-injury. Like many sports, rock climbing can become a lifestyle and result in a desire to push through injury. Knowledge specific to climbing injuries is necessary for both climbers and physical therapists to allow for optimal healing and return to sport.

Purpose:

With this project I wanted to combine rock climbing terminology and technique with anatomy/physiology, training principles, and current knowledge of rehabilitation methods. The audience was both PTs to learn about the unique demands of climbing and climbers to learn about preventing injury and understand the physiological side.

Products:

To accomplish this I consulted with my committee members who are PTs that currently treat climbers in the development of a PowerPoint that explains climbing demands in a more medical context. Based on what was found in the research to be the most commonly injured body region – the fingers – a large focus was on differential diagnoses for finger pain when climbing. I presented the PowerPoint to members of my climbing team after practice and shared the file with the rest of the members who were not able to make it that day. I will also be saving this PowerPoint as a resource that I can edit and add to for use in the future with climbing workshops at gyms or to pass along to other PTs who are interested in learning about treating the climber in their own practice. This initial version which was presented to climbers did not include many definitions of climbing terminology since they were familiar with that aspect of it, but if presenting to PTs I may add pictures and define types of climbing, how routes are graded for difficulty, explain basic climbing technique, etc.

I also put together an Evidence Table that included a look into the rehabilitation focused research I found to more thoroughly analyze what exactly they were looking at in these studies and identified practical climbing takeaways.

Self-Reflection:

I learned a lot about rehabilitating injuries of the fingers with this project. This is an area of the body that is less frequently treated by PTs typically but would be essential for the PT who treats rock climbers to master. I have definitely expanded my knowledge of potential diagnoses for finger pain and how to differentiate between them. What I most enjoyed about this project was the new perspective I gained for movement analysis and understanding of the physiological demands of specific components of rock climbing such as how different grips tax the muscles/tendons/pulleys. I also enjoyed seeing how climbing is now being utilized in the rehabilitation process to help these tissues recover in some of the research being done, rather than ceased all together. Although I found some of the return-to-sport protocols to be imprecise and not individualized enough for each climber, I appreciated taking the mindset of how to break down the sport into a graded return. For example, the Meyers protocol for return from epiphyseal fracture, manipulated the factors: number of training sessions per week, total training time of each session, climbing hold type (easier being larger holds with a positive edge), larger holds for feet, relatively vertical walls (versus steeper more overhung walls), and more static climbing (over dynamic powerful movements).9

Overall, I am pleased with what I have been able to accomplish with my project and am looking forward to future potential opportunities to continue exploring treatment of this population. During the course of this project, I was not able to shadow my mentor Chris Ball at his pro-bono climbing clinic at Triangle Rock Gym in Raleigh, but plan to do so in May which should be a great experience to see the treatment of these patients firsthand. Research in this field is very new and limited so I will continue to seek out the most current evidence for treatment approaches.

Acknowledgments:

I would like to thank my faculty advisor, Dr. Mike Lewek, PT, PhD for his support and guidance during the process of this project. I would also like to thank Todd Bushman, PT, DPT, CSCS and Chris Ball PT, DPT, CSCS for sharing their expertise working with rock climbers and providing me feedback along the way.

 

References:

  1. Lutter C, Tischer T, Cooper C, et al. Mechanisms of Acute Knee Injuries in Bouldering and Rock Climbing Athletes. Am J Sports Med. 2020;48(3):730-738. doi:10.1177/0363546519899931
  2. Jones G, Schöffl V, Johnson MI. Incidence, Diagnosis, and Management of Injury in Sport Climbing and Bouldering: A Critical Review. Curr Sports Med Rep. 2018;17(11):396-401. doi:10.1249/JSR.0000000000000534
  3. Schöffl V, Popp D, Küpper T, Schöffl I. Injury trends in rock climbers: evaluation of a case series of 911 injuries between 2009 and 2012. Wilderness Environ Med. 2015;26(1):62-67. doi:10.1016/j.wem.2014.08.013
  4. Woollings KY, McKay CD, Emery CA. Risk factors for injury in sport climbing and bouldering: a systematic review of the literature. Br J Sports Med. 2015;49(17):1094-1099. doi:10.1136/bjsports-2014-094372
  5. Jones G, Johnson MI. A critical review of the incidence and risk factors for finger injuries in rock climbing. Curr. Sports Med. Rep. 2016; 15:400–9. doi: 10.1249/JSR.0000000000000304. PubMed PMID: 27841811.
  6. Schweizer A. Lumbrical tears in rock climbers. J. Hand Surg. Br. 2003; 28:187–9.
  7. Schneeberger M, Schweizer A. Pulley ruptures in rock climbers: Outcome of conservative treatment with the pulley-protection splint—a series of 47 cases. Wilderness & Environmental Medicine. 2016;27(2):211-218. doi:10.1016/j.wem.2015.12.017
  8. Schweizer A. Biomechanical properties of the crimp grip position in rock climbers. J Biomech. 2001;34(2):217-223. doi:10.1016/s0021-9290(00)00184-6
  9. Meyers RN, Schöffl VR, Mei-Dan O, Provance AJ. Returning to Climb after Epiphyseal Finger Stress Fracture. Curr Sports Med Rep. 2020;19(11):457-462. doi:10.1249/JSR.0000000000000770
  10. Bartschi N, Scheibler A, Schweizer A. Symptomatic epiphyseal sprains and stress fractures of the finger phalanges in adolescent sport climbers. Hand Surg Rehabil. 2019; 38:251–6.
  11. Schöffl V, Strohm P, Lutter C. Efficacy of corticosteroid injection in rock climber’s tenosynovitis. Hand Surg Rehabil. 2019;38(5):317-322. doi:10.1016/j.hansur.2019.07.004
  12. Simon, A. Rock climbing finger tenosynovitis. The Climbing Doctor. https://theclimbingdoctor.com/rock-climbing-finger-tenosynovitis/. Published February 19, 2023. Accessed April 3, 2023.
  13. Vagy J. Train antagonist strength for climbing. The Climbing Doctor. https://theclimbingdoctor.com/how-to-train-antagonist-muscle-strength-for-climbing/. Published November 19, 2022. Accessed April 5, 2023.
  14. Peterson C, Ceraulo A. Caring for Climbers. Curr Sports Med Rep. 2015;14(5):397-403. doi:10.1249/JSR.0000000000000200
  15. Moreside JM, McGill SM. Hip joint range of motion improvements using three different interventions. J Strength Cond Res. 2012;26(5):1265-1273. doi:10.1519/JSC.0b013e31824f2351
  16. Draga P, Ozimek M, Krawczyk M, et al. Importance and Diagnosis of Flexibility Preparation of Male Sport Climbers. Int J Environ Res Public Health. 2020;17(7):2512. Published 2020 Apr 7. doi:10.3390/ijerph17072512
  17. Schoffl I, Einwag F, Strecker W, Hennig F, Schoffl V. Impact of taping after finger flexor tendon pulley ruptures in rock climbers. J Appl Biomech. 2007;23(1):52-62. doi:10.1123/jab.23.1.52
  18. DeStefano M. Pocket change – adapting the way you pull on pockets. The Climbing Doctor. https://theclimbingdoctor.com/pocket-change-adapting-the-way-you-pull-on-pockets/. Published November 19, 2022. Accessed April 7, 2023.
  19. Jones G, Johnson R, Schöffl V, et al. Primary Periphyseal Stress Injuries of the Fingers in Adolescent Climbers: A Critical Review. Curr Sports Med Rep. 2022;21(12):436-442. Published 2022 Dec 1. doi:10.1249/JSR.0000000000001016
  20. Kozin S, Cretu M, Kozina Z, et al. Application of closed kinematic chain exercises with eccentric and strength exercises for the shoulder injuries prevention in student rock climbers: a randomized controlled trial. Acta Bioeng Biomech. 2021;23(2):159-168.
  21. McGowan CJ, Pyne DB, Thompson KG, Rattray B. Warm-Up Strategies for Sport and Exercise: Mechanisms and Applications. Sports Med. 2015;45(11):1523-1546. doi:10.1007/s40279-015-0376-x

5 Responses to “Rock Climbing Injuries”

  1. Ashlyn Warren

    Sammi,
    I love this project idea and think it perfectly demonstrates your passion and knowledge for climbing. I have learned so much through your Capstone materials on the common injuries, risk factors, and rehabilitation considerations for climbers. This is certainly a niche area and one that I think you could make a huge difference in working in. I cannot wait to see all you accomplish in your career. Thank you so much for sharing this knowledge. Great work!

    Reply
  2. Lauren Mihalek

    Sammi, it has been so fun watching your passion for climbing and physical therapy grow throughout grad school! As someone outside of the rock climbing space, I had no idea about the specific physical demands that rock climbers face. Your project is unique and fascinating, and I learned a lot from it! I especially loved all of the pictures and visuals, as they really helped me conceptualize the topics discussed in the presentation. I’m so excited to see all that you accomplish during your sports residency at USC!

    Reply
  3. Austin Kliewer

    Sammi,
    This is such an interesting topic and one that I know you are very passionate and (now even more) knowledgeable about. I learned a lot from your presentation regarding the unique demands for climbers and the common injuries – especially relating to the fingers and hand. Your work on this made me appreciate even more those who are able to effectively understand and treat those with these injuries, and more broadly, the population of rock climbers. You’ve made great connections within this community and I’m certain that you will go on to do amazing things in your career!

    Reply
  4. hearrow

    Sammi, your project is so cool! Even cooler because climbing has become something you love so much! I agree with you that this is an area where there is so much room for more education. The hand and fingers are complex to begin with, and throwing in a grip dominated sport makes them even harder to treat! I once had a climber patient and was rather lost with where to begin in his rehabilitation, even though I’ve spent a fair amount of time in a climbing gym. The PowerPoint you created is a great resource for physical therapists, and can be used by climbers who may have an injury they want to self-diagnose. I know you put a lot of time and effort into this project and you should be very proud of the final result!

    Reply
  5. Mike Lewek

    Sammi – You took on a challenging project by trying to merge climbers knowledge with some rehabilitation knowledge of climbing injuries. You have the unique opportunity to see this from both sides (as a climber and PT yourself). You have sought out experts in the field and I am equally grateful for your fantastic committee members for working with you and providing their content expertise with you. You did a really nice job on this project and you should be proud of yourself.
    Mike

    Reply

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